NEPHROTIC SYNDROME - DIET

Jesal Shah*Consultant Dietician, Mumbai*

Nephrotic syndrome

occurs when filters in kidney leak an excessive amount of protein. The level of protein in the blood then falls and this allows fluid to leak across very small blood vessels into the tissues. Swelling around the eyes, abdomen and legs is a consequence of this process.

The disease is characterised by proteinuria (Excessive protein especially albumin in the urine), low blood protein and oedema (swelling in tissues). Protein losses in the urine are commonly 5-10gms per day but may also exceed 30gms per day.

Nutritional management: One of the aims of nutritional management is to replace as much of the protein loss in the urine by a intake of good quality protein. The dietary modification may be as follows:

- Protein: A balanced diet adequate in both energy and protein (1-2gm per kilogram body weight) should be adequate for most children. Since Indian children usually have a low intake of protein (even less than the RDA), adequate protein intake - up to 2gm/kg/day in children and not more than 3gm/kg/day in infants is advocated. A very high protein diet may cause tubular damage to the kidneys as the kidneys will have to filter more of the proteins.

- Calories: A high calorie diet so as to conserve protein should be necessary. However, fat content is not increased in the diet as

patients with nephrotic syndrome

have high serum triglycerides.

- Sodium: To prevent massive oedema, sodium levels in the diet must be low. Usually 500mg sodium diet is satisfactory. Salt should be restricted but diets should be palatable. Usually added salt is prohibited in these children. Table below indicates some of the foodstuffs high in sodium:

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